Background: Transurethral resection of the prostate (TURP) is a standard surgical intervention for benign prostatic enlargement (BPE). Pre-treatment with 5α-Reductase inhibitors has been suggested to optimize surgical outcomes by reducing prostate volume and vascularity. This study aimed to compare the outcomes of TURP in patients pre-treated with 5α-Reductase inhibitors for 3 months versus those treated with TURP alone. Methods: A prospective, randomized controlled trial was conducted involving 200 patients aged 50-80 years with symptomatic BPE requiring surgical intervention. Patients were randomized into two groups: Group A (n=100) received 5α-Reductase inhibitors (finasteride 5mg or dutasteride 0.5mg) daily for 3 months prior to TURP, while Group B (n=100) underwent TURP alone. The primary outcomes were intraoperative bleeding, postoperative complications assessed using the Clavien-Dindo classification, and improvement in International Prostate Symptom Score (IPSS) at 3 months postoperatively. Results: Group A demonstrated a significant reduction in intraoperative bleeding compared to Group B (150 ± 50 mL vs. 200 ± 60 mL, p<0.001). Postoperative complications were comparable between the two groups (p=0.54). Group A showed a more favorable improvement in IPSS compared to Group B at 3 months postoperatively (15 ± 5 vs. 12 ± 4, p=0.002). Conclusion: Pre-treatment with 5α-Reductase inhibitors significantly reduces intraoperative bleeding and improves short-term urinary symptoms in BPE patients undergoing TURP. However, this reduction in bleeding does not translate into a significant reduction in postoperative complications. Future studies with longer follow-up periods are required to assess the impact of 5α-Reductase inhibitors on long-term postoperative outcomes and complications.